Background
In Malawi, many children living with HIV, particularly those in underserved communities, are not identified and diagnosed. HIV testing efforts are often broad rather than targeted, resulting in relatively few positive cases being found among large numbers of children tested. According to the Malawi National AIDS Commission, paediatric antiretroviral therapy (ART) coverage remains low, with only 58% of children aged 0 to 14 living with HIV receiving treatment as of December 2024.
Access to healthcare is a major challenge in the districts of Phalombe, Mulanje, and Chikwawa, where some communities must travel up to 15 kilometres to reach the nearest health facility. High population density, migration to tea plantations, poverty, population movement and difficult geographical access to health facilities further limit access to HIV testing, treatment, and ongoing care. In Mulanje District, HIV prevalence is estimated at 14%, significantly higher than the national average of 8.9%.
Objectives
The project improves access to HIV testing, treatment and care for children and families in underserved communities in Phalombe, Mulanje and Chikwawa districts by:
- Ensuring more children and mothers at high risk of HIV are identified and tested through targeted community outreach in underserved areas.
- Ensuring children diagnosed with HIV start treatment quickly, remain in care and achieve viral suppression through strengthened referral systems and psychosocial support.
- Promoting lasting improvements in paediatric HIV services by generating evidence and advocating for the integration of successful community approaches into government policies, guidelines and programmes.
The project particularly focuses on children (0-14) and adolescents living with or at risk of HIV,
pregnant and lactating mothers, and families of children affected by HIV.
Contribution to the Paediatric HIV Partnership
This project and its partners are part of the Paediatric HIV Partnership. As part of the Partnership, COWLHA contributes a community-led, last-mile approach to paediatric HIV case finding and linkage to care. The project generates evidence through Community-Led Monitoring, providing insights into the barriers, gaps and effective approaches to reaching children who are missed by existing health services.
By documenting outcomes and lessons learned, the project contributes to the Partnership’s shared evidence base on effective community-led approaches to paediatric HIV, helping to strengthen paediatric HIV programming in Malawi and beyond. Evidence and learning will be shared through technical working groups, conferences and engagement with national and district stakeholders. COWLHA and Y+ will use project and Community-Led Monitoring data to advocate with the Ministry of Health and National AIDS Commission for stronger paediatric HIV policies, guidelines and services, including targeted paediatric HIV testing, safe spaces for children, strengthened community-led care and support, and adoption of relevant elements of the Kids to Care Model.
This contributes to the Partnership’s broader goal of ensuring that every child living with HIV can access timely diagnosis, treatment and lifelong care.
